Provider Demographics
NPI:1831747237
Name:RO, ELISHA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELISHA
Middle Name:
Last Name:RO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9614 63RD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2255
Mailing Address - Country:US
Mailing Address - Phone:718-777-8111
Mailing Address - Fax:
Practice Address - Street 1:9614 63RD DR STE 100
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2255
Practice Address - Country:US
Practice Address - Phone:718-777-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY065797OtherNEW YORK STATE BOARD OF PHARMACY